Borderline Personality Disorder Symptomatology Research Articles

A Narrative Systematic Review of the Effectiveness of Repetitive Transcranial Magnetic Stimulation (rTMS) in the Treatment and Management of Borderline Personality Disorder

Background: Borderline Personality Disorder (BPD) is a psychiatric condition that affects approximately 2% of the population worldwide. It can present many challenges and can therefore be difficult to treat successfully by mental health professionals. Aim: The aim of this systematic review was to detect whether repetitive Transcranial Magnetic Stimulation (rTMS) is an effective intervention for the management of BPD to the point where there would be a reduction of the BPD symptoms and challenging behaviour. Methods: A literature search was conducted systematically using the following databases: PROSPERO, PUBMED, GOOGLE SCHOLAR, WEB OF SCIENCE, COCHRANE LIBRARY, SCOPUS, EMBASE and CLINICALTRIALS.GOV. Included studies were primary research studies of adult patients with a diagnosis of BPD who received rTMS treatment. Results: Nine studies were identified which ranged from a case report to a randomised controlled trial (RCT). While rTMS improved certain symptoms of BPD patients, such as affective instability, impulsivity and outbursts of anger; overall, some results lacked statistical significance and, due to the lack of robust evidence, it is uncertain if rTMS is an effective intervention for BPD. Conclusions: rTMS treatment showed some promising results in reducing the severity of symptoms for a number of patients. Studies varied with regard to the location of the target stimulation site, including different prefrontal brain regions and the cerebellum, as well as other rTMS protocol characteristics. These methodological differences in the application of the intervention and their impact on BPD symptomatology need to be explored more systematically in future research. Higher quality studies with larger sample sizes are needed in order to assess further the effectiveness of rTMS interventions on BPD symptoms.

Assessing family relations in borderline personality disorder: A relational approach.

The aims of the current study are to describe the basic family relationships, parental bonding patterns, and dyadic adjustment of families with offspring diagnosed with borderline personality disorder (BPD)and to explore the correlations between these variables related to family relations and BPD symptomatology. The sample consisted of 194 participants, including parents from the control (N = 76) and clinical group (N = 76), and patients with BPD(N = 42). All progenitors completed a measure of family relations, parental bonding, and dyadic adjustment. Patients completed a measure of parental bonding and borderline symptomatology. The results showed significant differences between both groups in marital and parental functioning, marital satisfaction, dyadic adjustment, and care. Correlations among family variables and BPD symptomatology were also found. In summary, findings underscore the significance of comprehending the complexity of family relationships in BPD while advocating for a relational perspective when examining the family dynamics.

The quest for a biological phenotype of adolescent non-suicidal self-injury: a machine-learning approach

Non-suicidal self-injury (NSSI) is a transdiagnostic psychiatric symptom with high prevalence and relevance in child and adolescent psychiatry. Therefore, it is of great interest to identify a biological phenotype associated with NSSI. The aim of the present study was to cross-sectionally investigate patterns of biological markers underlying NSSI and associated psychopathology in a sample of female patients and healthy controls. Comprehensive clinical data, saliva and blood samples, heart rate variability and pain sensitivity, were collected in n = 149 patients with NSSI and n = 40 healthy participants. Using machine-based learning, we tested the extent to which oxytocin, dehydroepiandrosterone (DHEA), beta-endorphin, free triiodothyronine (fT3), leukocytes, heart rate variability and pain sensitivity were able to classify participants regarding their clinical outcomes in NSSI, depression and borderline personality disorder symptomatology. We evaluated the predictive performance of several models (linear and logistic regression, elastic net regression, random forests, gradient boosted trees) using repeated cross-validation. With NSSI as an outcome variable, both logistic regression and machine learning models showed moderate predictive performance (Area under the Receiver Operating Characteristic Curve between 0.67 and 0.69). Predictors with the highest predictive power were low oxytocin (OR = 0.55; p = 0.002), low pain sensitivity (OR = 1.15; p = 0.021), and high leukocytes (OR = 1.67; p = 0.015). For the psychopathological outcome variables, i.e., depression and borderline personality disorder symptomatology, models including the biological variables performed not better than the null model. A combination of hormonal and inflammatory markers, as well as pain sensitivity, were able to discriminate between participants with and without NSSI disorder. Based on this dataset, however, complex machine learning models were not able to detect non-linear patterns of associations between the biological markers. These findings need replication and future research will reveal the extent to which the respective biomarkers are useful for longitudinal prediction of clinical outcomes or treatment response.

A 12-month study of dialectical behavioral therapy for bοrderline patients suffering from eating disorders

PurposeIndividuals with eating disorders (ED) and comorbid borderline personality disorder (BPD) may benefit from therapies focusing on emotion regulation, such as dialectical behavioral therapy (DBT). The aim of the study was to evaluate the effectiveness of one-year standard DΒΤ enhanced with cognitive-behavioral therapy (CBT) strategies for patients suffering from ED and BPD.MethodsSeventy-two BPD and ED (anorexia and bulimia nervosa) participants were recruited from the eating disorders unit of the 1st Psychiatric Department of National and Kapodistrian University of Athens. All participants completed one year of standard DBT. ED-related behaviors were added to the treatment plan according to the DBT targeting hierarchy. Individual therapy and skills training group sessions were adapted to incorporate CBT strategies for nutritional and weight restoration. BPD and ED symptomatology were measured at the beginning and at the end of one year of treatment.ResultsThe major finding of the study was the significant improvement of patients in all the outcome measurements after one year of treatment. The study's second finding was that the severity of BPD symptomatology was significantly related to the severity of ED symptomatology. It was also shown that improvement of the patients coping skills was correlated with the reduction of ED and BPD symptomatology.ConclusionsThese results support previous studies on the effectiveness of DBT for comorbid BPD and EDs. Despite the promising results, randomized controlled trials are needed to establish the efficacy of DBT for BPD and ED patients.Level of evidenceLevel IV: Evidence obtained from multiple time series with or without the intervention, such as case studies. Dramatic results in uncontrolled trials might also be regarded as this type of evidence.

Psychometric properties of the Chinese Mandarin version of the Borderline Symptom List, short form (BSL-23) in suicidal adolescents

BackgroundThe short form of the Borderline Symptom List (BSL-23) is a self-rated instrument developed from the initial 95-item German version of the Borderline Symptom List (BSL-95). It is widely used among Chinese adults, but its applicability, factor structure and validity remain uncertain in adolescents. This study aimed to evaluate the psychometric properties of the Chinese Mandarin version of the BSL-23 in a sample of suicidal adolescents.MethodsThe Chinese Mandarin BSL-23 was given to 279 outpatient adolescents with self-injurious thoughts or behaviors. The factor structure, reliability, convergent validity, criterion-related validity and cut-off value were investigated.ResultsThe Chinese Mandarin version of the BSL-23 demonstrated a one-factor structure and replicated the original version. The scale had high reliability and good test-retest stability. The Chinese Mandarin BSL-23 was correlated with depression, hopelessness, impulsivity, emotional dysregulation, self-esteem, loneliness, childhood trauma and parental bonding patterns evaluated with a variety of scales. The measure showed good criterion-related validity and predictive accuracy (AUC = 0.87) for self-injurious and suicidal adolescents with borderline personality disorder (BPD) at a cut-off point of 60/61 (mean score 2.60/2.65), with a sensitivity of 0.76 and specificity of 0.83.ConclusionsThe Chinese Mandarin version of the BSL-23 is a reliable and valid self-reported instrument to assess BPD symptomatology among suicidal adolescents.

The Pathology of Borderline Personality Disorder Symptomatology in a Nonclinical Sample: The Role of Mental Pain, Cognitive Emotion Regulation, Self-compassion, and Depression

Objectives: Patients with borderline personality disorder (BPD) often develop a certain depression that may be accompanied by “mental pain.” A negative self-concept, aversive chronic emotions, and pervasive helplessness characterize mental pain. This research aims to explore the pathology of BPD symptomatology in a nonclinical sample. Also, the role of mental pain, cognitive emotion regulation, self-compassion, and depression are assessed. Methods: Following a correlational study, 300 university students were selected via the multi-stage random cluster sampling method. The study data were collected by the personality assessment inventory-borderline features scale, Orbach and Mikulincer mental pain questionnaire, cognitive emotion regulation questionnaire, self-compassion scale (SCS-SF), and Beck depression inventory version 2. Results: Multiple regression analyses indicated that components of putting into perspective, rumination, loss of control, refocus on planning, catastrophizing, irreversibility, somatic, and isolation (ΔR2=0.507, P<0.001) significantly predicted BPD symptomatology. Discussion: The results support the biosocial model dimensions in an Iranian context. In addition, it shows a strong association between mental pain, cognitive emotion regulation, self-compassion, depression, and BPD symptoms.

Emotion dysregulation, impulsivity and anger rumination in borderline personality disorder: the role of amygdala and insula

Borderline Personality Disorder (BPD) is a severe mental disorder, characterized by deficits in emotion regulation, interpersonal dysfunctions, dissociation and impulsivity. Brain abnormalities have been generally explored; however, the specific contribution of different limbic structures to BPD symptomatology is not described. The aim of this study is to cover this gap, exploring functional and structural alterations of amygdala and insula and to highlight their contribution to neuropsychiatric symptoms. Twenty-eight BPD patients (23.7 ± 3.42years; 6M/22F) and twenty-eight matched healthy controls underwent a brain MR protocol (1.5T, including a 3D T1-weighted sequence and resting-state fMRI) and a complete neuropsychiatric assessment. Volumetry, cortical thickness and functional connectivity of amygdala and insula were evaluated, along with correlations with the neuropsychiatric scales. BPD patients showed a lower cortical thickness of the left insula (p = 0.027) that negatively correlated with the Anger Rumination Scale (p = 0.019; r = -0.450). A focused analysis on female patients showed a significant reduction of right amygdala volumes in BPD (p = 0.037), that correlate with Difficulties in Emotion Regulation Scale (p = 0.031; r = - 0.415), Beck Depression Inventory (p = 0.009; r = - 0.50) and Ruminative Response Scale (p = 0.045; r = - 0.389). Reduced functional connectivity was found in BPD between amygdala and frontal pole, precuneus and temporal pole. This functional connectivity alterations correlated with Anger Rumination Scale (p = .009; r = -0.491) and Barratt Impulsiveness Scale (p = 0.020; r = -0.447). Amygdala and insula are altered in BPD patients, and these two limbic structures are implicated in specific neuropsychiatric symptoms, such as difficulty in emotion regulation, depression, anger and depressive rumination.

The effectiveness of psychological interventions for borderline personality disorder for those who misuse substances: a systematic review and narrative synthesis

Purpose This study aims to identify and critically appraise literature exploring the effectiveness of psychological interventions in improving borderline personality disorder (BPD) symptomatology for individuals who misuse substances. Design/methodology/approach Systematic searches across six databases (PsycINFO, Embase, Scopus, Medline, CINAHL and ProQuest), hand searching and citation chaining were conducted between June and August 2021. Key search terms included BPD, substance use, therapy and effect. Study and sample characteristics, interventions, outcome measures and key findings were extracted. Quality assessment and a narrative synthesis approach were used to explore strengths, limitations and relationships between and within studies. Findings Seven eligible reports were included and showed mostly adequate quality. Mixed samples, designs, outcomes, definitions and implementation varied. Treatment completion did not differ significantly between those who did and did not misuse substances. Interventions demonstrated effectiveness in relation to psychiatric symptoms, hospital admissions, self-efficacy and impulsive and self-mutilating (cutting, burning, etc.) behaviours. No effects were found for suicidal or parasuicidal (threats, preparation and attempts) behaviours. Research limitations/implications This review only considers individuals with diagnoses of BPD who are not accessing substance misuse treatment. Radically open dialectical behaviour therapy (DBT), therapeutic communities and other interventions are available as interventions for substance misuse (Beaulieu et al., 2021). Based on the findings of this review, it should not be assumed that such interventions affect substance misuse rather than BPD symptomatology. Therefore, future research might explore the effectiveness of these interventions on BPD symptomatology despite this not being the primary target for intervention. Practical implications Despite McCrone et al. (2008) noting the cost of this population’s difficulties to both themselves and services, the limited number of studies in this area is astonishing. Despite a lack of quality in the data available, there i some evidence to support the use of DBT and general psychiatric management (GPM) interventions for those with BPD and concurrent substance misuse. It is therefore of principal importance that health and social care services action Public Health England’s (2017) recommendations. Individuals with coexisting BPD and substance misuse would then receive support from any professional they see, who could then refer for psychological therapies. Originality/value Although the reports appear to show that DBT, integrated therapies and GPM may be effective for this population, conclusions cannot be drawn with high levels of confidence due to heterogeneity among studies. The findings indicate that future, high-quality research is needed to test the effects of interventions on BPD symptomatology for those who misuse substances. Randomised controlled trials with sufficient statistical power, homogeneous outcomes and standardised methodological approaches are needed.

Executive Function Deficits and Borderline Personality Disorder Symptomatology in a Nonclinical Adult Sample: A Latent Variable Analysis.

While borderline personality disorder (BPD) symptomatology has been studied extensively in clinical populations, the mechanisms underlying its manifestation in nonclinical populations remain largely understudied. One aspect of BPD symptomatology in nonclinical populations that has not been well studied is cognitive mechanisms, especially in relation to executive functions. To explore the cognitive mechanisms underlying BPD symptomatology in nonclinical populations, we analysed a large-scale dataset of 233 young adults that were administered with nine executive function tasks and BPD symptomatology assessments. Our structural equation modelling did not find any significant relations between latent factors of executive functions and the severity of BPD symptomatology. Contrary to our hypothesis, our result suggests that deficits in executive functions were not a risk factor for BPD symptomatology in the nonclinical young adult sample.

Are there underlying differences between sexually diverse and non-sexually diverse people diagnosed with Borderline Personality Disorder?

ABSTRACT Previous studies have demonstrated that people with Borderline Personality Disorder (BPD) are more likely to report a sexually diverse orientation (e.g gay, lesbian) than people with other or no psychiatric condition(s). Past literature has attempted to link the BPD symptoms of impulsivity (causing an increase in varied sexual behaviour) and identity disturbance (causing changes in sexual identity) to this overrepresentation. This however can be stigmatising and possibly suggest sexual diversity orientation as a pathology. To address this, the current study aimed to explore this overrepresentation in a more sensitive manner, and examine whether sexually diverse and non-sexually diverse people with BPD differ significantly in demographics, overall BPD symptomatology, identity disturbance, and impulsivity. An online survey was completed by 162 participants (152 cisgender female, 5 cisgender male, and 5 non-binary/third gender; mean age 33.01 years [SD = 9.44]); who self-reported receiving a diagnosis of BPD. Survey data included questions concerning demographics, respondents’ mental health (such as diagnoses, treatment status) and aspects of their sexuality (identity, attraction, relationship history), in addition to the measurement of BPD symptomatology (MSI-BPD), identity disturbance (SCIM), and impulsivity (UPPS-P). Survey data analysis suggested that sexually diverse individuals with BPD were younger than their non-sexually diverse (heterosexual) peers and were more likely to have changed their self-labelled sexual identity during the previous year. There were no significant differences in other demographic factors, BPD symptomatology, identity disturbance or impulsivity. The study clearly highlighted the challenges of using a single criterion to define sexual diversity, as the groups differed markedly according to whether classification was based on current and past relationship history, sexual attraction, or self-labelled sexual identity. The findings also suggest that BPD symptoms of identity disturbance and impulsivity may not explain the overrepresentation of sexual diversity in people diagnosed with BPD, and that further investigation is warranted.

How Will You Feel on Valentine's Day? Affective Forecasting and Recall Biases as a Function of Anxiety, Depression, and Borderline Personality Disorder Features.

The prediction of affective experiences, also known as affective forecasting, is an integral component of individuals' decision-making processes. Yet, research consistently demonstrates that affective forecasts (AF) and recollections (AR) are generally inaccurate. Recent research has demonstrated distinct patterns of AF/R bias related to psychopathology. The present study examined the relationship between AF/R and features of Borderline Personality Disorder (BPD), anxiety, and depression using Valentine's Day as the target event. Undergraduate students (N=263; 33% white; 63% female; Mage=19.08) predicted their affective states a week before, and then reported their actual affective states on Valentine's Day and the two days after, and recalled Valentine's Day affect two days later. Results indicate that higher BPD symptomatology predicted a significant overestimation of negative affect (B=.17, p=.02), even after controlling for anxiety and depression. Additionally, individuals' levels of depressive, anxious, and BPD symptomatology were significant predictors of AF of positive affect when entered into regression analyses separately, however when entered together, only depressive symptoms remained significant. Specifically, higher depressive symptoms predicted a significant underestimation of positive affect (B=-.21, p=.01). Results were in line with prior research indicating that unique patterns of AF biases are associated with symptoms of psychopathology. However, results failed to support prior research linking AR biases to symptoms of psychopathology. Implications for future studies of affective biases and psychopathology more generally are discussed.

Mentalizing in first-episode psychosis: Correlates with symptomatology and traits of borderline personality disorder.

To explore the associations between mentalizing, positive and negative symptoms of psychosis, and traits of borderline personality disorder, in a sample of patients with first-episode psychosis, and in a non-clinical sample. A quantitative cross-sectional design was employed. Thirty-two adults with first-episode psychosis and 148 non-clinical participants were assessed using the reflective functioning questionnaire. The questionnaire measures two dimensions of mentalizing, certainty and uncertainty about mental states. Traits of borderline personality disorder and symptoms of psychosis were measured using the self-report version of the Zanarini rating scale, the Community Assessment of Psychotic Experiences, and the Green et al., paranoid thought scale. Patients with first-episode psychosis reported increased mentalizing impairments, characterized as hypomentalizing tendencies, compared to the non-clinical group. Regression analysis showed significant associations between higher scores on the uncertainty about mental states scale and negative symptoms of psychosis in both groups. No associations were found between mentalizing impairments and traits of borderline personality disorder in the clinical sample, although associations were found in the non-clinical sample. The present findings suggests that impairments in mentalizing may be associated with negative symptoms of psychosis across both clinical and non-clinical samples. Mentalizing impairments was found to be associated with traits of borderline personality disorder, but this finding was only confirmed in the non-clinical sample. Mentalizing should therefore be considered in the early assessment and treatment of patients experiencing difficulties with negative symptoms of psychosis.

Trajectories and Processes of Symptom Change Over Time in Dialectical Behavior Therapy for Borderline Personality Disorder

Despite ample evidence for Dialectical Behavior Therapy (DBT) as an effective treatment for borderline personality disorder (BPD), close examination of the trajectory of change in BPD symptoms over the course of DBT is lacking. There also remain questions regarding the directionality of changes in different domains of BPD symptoms, such as improvements in dysfunctional behaviors and thoughts/feelings. In order to provide more fine-grained information about the treatment process in DBT, the current study aimed to (a) examine the trajectories of change of BPD-associated negative thoughts/feelings and behaviors, and positive behaviors, and (b) test the temporal relationship between changes in negative behaviors and thoughts/feelings. The study involved 55 adult clients attending a 6-month outpatient DBT program for BPD who completed assessments of BPD symptoms every four sessions. Growth curve models suggested that clients experienced a faster rate of decrease in negative behaviors during the initial phase of treatment, whereas steady rates of improvement were found for negative thoughts/feelings and positive behaviors, respectively, throughout treatment. Further, a random-intercept cross-lagged panel model found that the within-person fluctuations in negative behaviors preceded the within-person changes in negative thoughts/feelings at a subsequent time point during the later phase of treatment, whereas within-person fluctuations in thoughts/feelings were followed by changes in negative behaviors at the beginning and end of the treatment. These results highlighted the complexity of patterns and processes of change in BPD symptomatology during the course of DBT.

An Examination of Stress Generation and Stress Exposure Models in Relation to Symptoms of Borderline Personality Disorder

Research examining life stress as a precipitant, co-occurrence, and consequence of psychopathology often has implications for two explanatory models: stress exposure, where stress causes symptoms, and stress generation, where symptoms cause stress. Preliminary evidence suggests that both processes are evident in borderline personality disorder (BPD). The present study examined 101 adults who self-reported at least three symptoms of BPD at prescreen, with 30% of the sample meeting full diagnostic criteria for BPD. Cross-lagged panel analyses were used to examine the relationships between BPD symptomatology and four forms of life stress. Stress exposure and stress generation were not supported for either form of chronic life stress. Results supported stress generation in both dependent and interpersonal episodic life stress, and stress exposure for interpersonal episodic life stress. These findings evidenced small effects only. Findings point to the impact of interpersonal stress on changes in symptomatology over time.

Nonsuicidal Self-Injury in Early Adolescence as a Predictor of Borderline Personality Disorder in Early Adulthood

Borderline personality disorder (BPD) typically has an onset in adolescence. Nonsuicidal self-injury (NSSI) could be associated with its subsequent development. The aim of this study was to examine whether NSSI among adolescents in the community is associated with a risk for BPD in emerging adulthood. Sixty-nine adolescents (11-13 years old) with a history of NSSI and 61 matched controls were assessed for NSSI and then reassessed between ages 18 to 20 years. Findings showed that continuation of NSSI over time was associated with higher ratings of BPD symptomatology and greater impairment in psychosocial functioning. Both of these relations were mediated by deficits in emotion regulation. These results suggest that adolescents who engage in NSSI may need to be assessed for problems regulating emotions and to be provided with early interventions to help prevent continuation of NSSI.

The Cognitive, Ecological, and Developmental Origins of Self-Disturbance in Borderline Personality Disorder.

Self-disturbance is recognized as a key symptom of Borderline Personality Disorder (BPD). Although it is the source of significant distress and significant costs to society, it is still poorly specified. In addition, current research and models on the etiology of BPD do not provide sufficient evidence or predictions about who is at risk of developing BPD and self-disturbance, and why. The aim of this review is to lay the foundations of a new model inspired by recent developments at the intersection of social cognition, behavioral ecology, and developmental biology. We argue that the sense of agency is an important dimension to consider when characterizing self-disturbances in BPD. Second, we address the poorly characterized relation between self-disturbances and adverse life conditions encountered early in life. We highlight the potential relevance of Life-History Theory—a major framework in evolutionary developmental biology—to make sense of this association. We put forward the idea that the effect of early life adversity on BPD symptomatology depends on the way individuals trade their limited resources between competing biological functions during development.

Mindfulness training for borderline personality disorder: A systematic review of contemporary literature.

Mindfulness is a component of several psychotherapies. Nonetheless, its effectiveness in borderline personality disorder (BPD) management remains obscure. This systematic review examined the effect of mindfulness training in BPD patients. Cochrane Central Register of Controlled Trials, CAB Abstracts, Embase, MEDLINE and APA PsycInfo were searched until 30 June 2021. Five trials with 294 participants were included. Improvements were reported in participants' levels of impulsivity, in their emotion dysregulation patterns, in their attention skills and in their mindfulness-related capacities including decentering and nonjudging. The findings suggest that mindfulness training may be an effective tool for alleviating certain aspects of BPD symptomatology. More research is needed before definitive conclusions can be reached about the effectiveness of mindfulness training in the treatment of BPD patients, and this remains to be elucidated in larger structured clinical trials, with longer follow-ups.

Attentional Tendencies That Impact Emotion Regulation Success Within a Borderline Personality Disorder Framework

Emotion regulation difficulties are key to borderline personality disorder (BPD) symptomatology. Literature indicates that attentional distraction, particularly within an interpersonal context, is common in BPD. Conversely, reappraisal tactics are less prevalent. The goal of the current study was to examine whether this discrepancy is observed when individuals reporting varying levels of BPD tendencies are given the choice of a preferred emotion regulation tactic when confronted with BPD-relevant stressors. Attentional engagement patterns, affective responses, and strategy success were also examined. Participants (N = 103) reported BPD tendencies as assessed by the Personality Assessment Inventory and were instructed to choose either to "distract" or to "reappraise" in response to affective images. Results revealed more instances of failing to implement distraction among individuals with higher BPD tendencies, which was also reflected in greater fixation biases to distressing content within those images. Results are discussed in terms of the malleability of emotion regulation in BPD contexts.

Compliant patients with borderline personality disorder non-responsive to one-year dialectical behavior therapy: Outcomes of a second year

There is a lack of information in the literature on patients with borderline personality disorder (BPD) who do not respond sufficiently to the standard one-year dialectical behavior therapy (DBT). In this naturalistic, observational study, we compared 43 patients completing and responding to one year of DBT (m = 34.5 years, 83.7% women; first-year responders, R1) with 12 patients (m = 34.4 years, 91.7% women) with BPD who completed but did not respond clinically to the standard one-year DBT (first-year non-responders, NR1). We also followed the NR1's progress in treatment during a second consecutive year of DBT. Despite a lack of difference in clinical characteristics at baseline, progress of R1 and NR1 patients differed substantially and significantly during the first year of DBT. Over two years, the NR1 patients significantly improved on all outcome measures. However, most of the changes became significant only after 18 months of therapy. The proportion of NR1 patients attaining a Global Assessment of Functioning score > 60 after their second year of treatment was close to that of R1 patients (58.3% and 62.8%, respectively). Despite improvements in BPD symptomatology and an increased use of DBT skills, rates of reliable clinical change indicated that these NR1 patients remained vulnerable to depression and emotion regulation difficulties.

Efficacy of naltrexone in borderline personality disorder, a retrospective analysis in inpatients.

The endogenous opioid system is assumed to be involved in the pathophysiology of borderline personality disorder (BPD), and opioid antagonists may improve core features of BPD. The aim of this retrospective chart analysis was to evaluate the relative contribution of the opioid antagonist naltrexone and other psychotropic drugs in the improvement of overall symptomatology in BPD. One hundred sixty-one inpatients with BPD treated between January 2010 and October 2013 were classified as either treatment responders or non-responders. Treatment responders were defined as subjects with significant improvements in four or more symptoms from a defined symptom list. The relative contribution of all psychotropic drugs to improvement of BPD symptomatology was assessed by means of a stepwise logistic regression. None of the drugs applied contributed significantly to improvement, with the exception of naltrexone (odds ratio [OR] 43.2, p≤0.0001). Patients treated with naltrexone (N=55, 34%) recovered significantly more often. Higher doses of naltrexone were more effective (OR 791.8, p≤0.0001) than lower doses (OR 26.6, p≤0.0001); however, even low-dose treatment was better than any other pharmacological treatment. Naltrexone was associated with improvement in BPD in a dose-dependent manner. The present study provides additional evidence that dysregulation of the endogenous opioid system is implicated in the pathophysiology of BPD symptoms.